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Impairment of short‐term memory and Korsakoff syndrome are common in AIDS patients with cytomegalovirus encephalitis
Author(s) -
PirskanenMatell R.,
Grützmeier S.,
Nennesmo I.,
Sandström E.,
Ehrnst A.
Publication year - 2009
Publication title -
european journal of neurology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.881
H-Index - 124
eISSN - 1468-1331
pISSN - 1351-5101
DOI - 10.1111/j.1468-1331.2008.02337.x
Subject(s) - medicine , cytomegalovirus , encephalitis , pediatrics , cerebrospinal fluid , neurological examination , pathology , human immunodeficiency virus (hiv) , immunology , surgery , virus , viral disease , herpesviridae
Background and purpose The diagnosis of cytomegalovirus encephalitis (CMV‐E) in AIDS patients is challenging as other illnesses may obscure the symptoms. Here, we characterize the clinical symptoms of CMV‐E and link them to post‐mortem findings. Patients and methods In 254 homosexual men with AIDS, followed from HIV diagnosis to death before the antiretroviral combination therapy era, CMV‐E was suspected in 93 cases. All were CMV‐positive in blood. Neurological examination, including cognitive testing was performed in 34 of them within 6 months before death. CMV‐E was diagnosed by CMV‐PCR in cerebrospinal fluid ( n = 24) or by post‐mortem ( n = 24). Results The majority complained of forgetfulness (91%), balance difficulties (85%) and impotence (85%). Impaired short‐term memory was present in 29 patients. It was extreme in 17, justifying the diagnosis of Korsakoff’s syndrome. This was often associated with infectious CMV in blood ( P = 0.01). Brainstem symptoms were found in 19 patients. Post‐mortem examination often revealed ventriculoencephalitis. CMV was found primarily around the ventricles and in other structures, described in Korsakoff′s syndrome. Conclusion The location of CMV in the brain corresponded well to the clinical findings, demonstrating the close relationship between the neurological symptoms and the neuroanatomical lesions.